Robert, I wonder if we might raise the bar a bit, at least in the behavioral area. Yes, we help people change -- but the only change that's meaningful in terms of illness risk-reducing behavior is long-term or permanent change. That's an area of deep mystery in our professions, since virtually every sort of risk-reducing intervention (for smoking, weight loss, dietary change, etc.) has a high degree of relapse or non-adherence. So the question I have about change is, what are the theories and processes we use to help people make long-term healthy change? My own answer to that question is informed in part by Deci and Ryan's Self-Determination theory, which suggests that people internalize new ideas and behaviors in an experiential continuum that ranges from highly conflicted ("my doctor told me to do this, but I really don't want to") to highly integrated with one's sense of self ("of course I do this, it wouldn't feel like me if I didn't"). The goal then is to develop interventions (they would say, "autonomy-supportive" interventions) that are experienced as being genuinely supportive and helpful and that encourage the patient's engagement and interest in the process of change in a way that leads to integrated internalization. For instance, researchers in D & R's group have found that attendance at weight loss sessions is predicted by the experience people have of the group leaders as being autonomy-supportive. Lots of potential in these ideas, I think, and some new research that I and some colleagues are doing at Rush-Presbyterian-St. Luke's Medical Center in Chicago is looking in part at how to promote more autonomy-supportive relationships and interactions between couples when one partner has heart disease and needs to change their lifestyle with the help of their spouse or partner. (We informally call it the "alternatives to nagging" study.) It's at least a start to answering this tough question, and I'd certainly be interested in hearing other people's ideas about how we can promote long-term behavioral change.
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